PHI-413V Topic 3 Assignment: Applying the Four Principles Case Study

Course: Ethical and Spiritual Decision Making in Health Care
Institution: Grand Canyon University
Assessment Type: Case Study Analysis with Chart and Evaluation
Total Points: 150 (Part 1: 60 points; Part 2: 90 points)
Submission: LopesWrite required

Assessment Description

This assignment incorporates a common practical tool in helping clinicians begin to ethically analyze a case. Organizing the data in this way will help you apply the four principles and four boxes approach. Based on the “Case Study: Healing and Autonomy” and other required topic Resources, you will complete the “Applying the Four Principles: Case Study” document that includes the following components.

Part 1: Chart (60 Points)

Based on the “Healing and Autonomy” case study, fill out all the relevant boxes below. Provide the information by means of bullet points with complete sentences in each box. Gather as much data as possible within this 1-page chart.

Part 2: Evaluation (90 Points)

Answer each of the following questions about how the four principles and four boxes approach would be applied.

Question 1 (200-250 words, 45 points)

According to the Christian worldview, how would each of the principles be specified and weighted in this case? Explain why.

Question 2 (200-250 words, 45 points)

According to the Christian worldview, how might a Christian balance each of the four principles in this case? Explain why.

Grading Rubric

Sample Answer Excerpts

Christian Worldview and Principle Weighting

In the Christian worldview, beneficence emerges as the most pressing principle in the “Healing and Autonomy” case study. Every decision Mike and Joanne made reflected their desire to act in James’s best interest, even when their initial choice to delay dialysis reflected a faith-driven conviction rather than malice. Christians believe God can heal, and the parents acted on this belief after witnessing a friend’s recovery from a stroke through prayer. The practice of beneficence involves taking appropriate and effective action to improve the lives of those in one’s care, and the parents demonstrated this intent by returning to the hospital when James’s condition worsened (Bester, 2020). Nonmaleficence follows closely because the parents never intended to harm James, and their eventual return to medical treatment shows a commitment to avoiding further damage. Autonomy ranks third because James is a minor and lacks decision-making capacity, though his perspective should have been sought. Justice ranks last because the case presents a conflict of interest involving Samuel as a potential donor, but the parents’ primary obligation remains to James’s recovery.

Balancing the Four Principles in Christian Ethics

A Christian balances the four principles by prioritizing love as the foundational ethic that governs all medical decisions. According to Christian teaching, love fulfills the law and eliminates the motivation to cause harm (Juujärvi et al., 2019). This means beneficence and nonmaleficence work together to ensure that parents, physicians, and guardians safeguard the safety of those in their care. The primary responsibility of a parent or physician is to protect the child’s well-being, and this duty supersedes concerns about autonomy when the patient is a minor. Justice and fairness follow because Christians are called to act equitably and to consider the welfare of all parties, including Samuel. Autonomy ranks last because the first three principles create an environment conducive to exchanging ideas and soliciting feedback. By discussing next steps with the patient and family, care providers show respect for input while maintaining the priority of doing good and avoiding harm. These principles are well-established in the Christian context and cannot be reorganized to suit individual preferences without undermining the ethical framework.

References

Bester, J. C. (2020). Beneficence, interests, and wellbeing in medicine: What it means to provide benefit to patients. The American Journal of Bioethics, 20(3), 53-62. https://doi.org/10.1080/15265161.2020.1721014

Dige, M. (2019). Lessons of reproductive ethics for principlism. Etikk i praksis – Nordic Journal of Applied Ethics, (1), 5-20. https://doi.org/10.5324/eip.v13i1.2843

Juujärvi, S., Ronkainen, K., & Silvennoinen, P. (2019). The ethics of care and justice in primary nursing of older patients. Clinical Ethics, 14(4), 187-194. https://doi.org/10.1177/1477750919874536

Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health, 17(3), 835. https://doi.org/10.3390/ijerph17030835

Follow-Up Analysis and Study Points

Principle Weighting in Christian Ethics

A Christian worldview does not treat the four principles as equally weighted in every case. When a minor’s life is at stake, beneficence and nonmaleficence take precedence because Scripture consistently commands believers to protect the vulnerable and to act with compassion (Hoehner, 2022). This case illustrates how faith and medicine can conflict when parents interpret divine healing as an alternative to clinical intervention. The Christian narrative affirms that God works through medicine and physicians, meaning that pursuing treatment is not a lack of faith. A study by the American Medical Association Journal of Ethics emphasizes that incorporating spirituality into patient care requires clinicians to respect religious beliefs while advocating for evidence-based interventions that prevent harm (Orr, 2015). The parents’ eventual return to dialysis demonstrates that faith and medical treatment can coexist when the primary goal is the child’s well-being.

Applying the Four Boxes to Pediatric Cases

Students often struggle to distinguish between parental autonomy and the child’s best interests in pediatric ethics. The four boxes approach clarifies this tension by separating medical indications from contextual features. In James’s case, the medical indications box clearly favors immediate intervention because acute glomerulonephritis is treatable with dialysis, and delayed treatment causes irreversible damage. The patient preferences box must account for James’s inability to consent and the parents’ role as surrogate decision-makers. A common misconception is that parental autonomy is absolute; in reality, courts and ethics committees routinely limit parental authority when decisions place a child at significant risk of harm. Another misconception concerns living organ donation from minors, which raises ethical concerns about voluntariness and the child’s inability to consent. The four boxes help clinicians structure these considerations without reducing the analysis to a single principle.

Ethical Decision-Making Frameworks

Clinicians facing similar dilemmas can use Jonsen’s four topics method to organize data and identify where principles conflict. This case demonstrates that the most difficult ethical decisions involve competing goods: the parents’ faith commitment and the child’s medical needs. Christian ethicists argue that love should guide the prioritization of principles, meaning that decisions should reflect concern for the most vulnerable party (Dige, 2019). In practice, this means that when a child’s life is at risk, beneficence and nonmaleficence outweigh autonomy claims that would delay or deny necessary treatment. Future nurses and physicians should recognize that ethical analysis is not about ranking principles abstractly but about applying them to specific circumstances with attention to context, relationships, and outcomes.

Conclusion

The “Healing and Autonomy” case study illustrates the complexity of applying biomedical principles within a Christian worldview. Mike and Joanne’s journey from faith-driven delay to medical intervention reveals that beneficence and nonmaleficence must anchor decisions when a child’s life is at stake. Autonomy matters, but it operates differently when the patient is a minor and the parents’ choices carry life-altering consequences. Justice demands that both James and Samuel receive equal moral consideration, especially when one child’s welfare depends on the other’s sacrifice. What makes this case instructive is not the conflict between faith and medicine but the way love, as a Christian ethic, reframes how principles should be weighted and balanced. The four boxes approach offers a structured method for navigating these tensions without losing sight of the people involved.

Next Assessment: Week 4 Benchmark – Patient’s Spiritual Needs Case Analysis

For Week 4, students will build on their Topic 3 chart and evaluation responses to complete a benchmark case analysis addressing the patient’s spiritual needs. The assignment requires a 750-1,000-word analysis that examines how Mike and Joanne’s spiritual needs intersect with James’s medical care. Students must answer questions about whether the physician should allow Mike to continue making decisions that appear irrational, how a Christian worldview informs the concept of autonomy in pediatric cases, and what spiritual care interventions would benefit the family. This assessment uses a rubric with criteria for decision-making and autonomy, spiritual needs assessment, and Christian worldview integration. Submission to LopesWrite is required, and students should reference the Topic 3 chart as a foundation for their analysis.